Payments to visiting medical officers in the ACT came under attack by the Auditor-General in a report tabled in the Legislative Assembly yesterday.
The Auditor found:
1. Evidence of (visiting) doctors charging for babies delivered by another (resident) doctor.
2. There are no procedures for verifying that VMOs actually provided the services claimed.
3. Allegations about obstetrics patients being asked to pay the VMO “”booking fees” of up to $500, where patients were booked in as public and treated by the VMO as private.
4. There were financial incentives for VMOs to make patients public patients at cost to the ACT.
5. VMOs are generally paid more than their counterparts in the states.
6. Only limited information for control and budget of VMO payments was available.
7. Papers on VMO contract negotiations in 1987 and 1990 could not be found.
The findings come at a critical time. The VMO contracts are up for renewal in November. If there is no agreement it will go to arbitration. A similar circumstance in NSW earlier this year led to doctors’ industrial action.
The report’s view that if the VMOs were paid the state average the ACT would be at least $1 million better off is likely to give the Government some ammunition in containing VMO costs. The 140 VMOs earned a total of $13.8 million last financial year, an average of $98,571.43. Most are specialists and most have work outside the hospitals.
The Auditor recommended a tightening up of procedures and payment at medical-benefits schedule rates. Many payments were now over this.
The Minister for Health and Industrial Relations, Wayne Berry, said the issues in the report were inherited from the Commonwealth but should have been addressed by the Alliance Government when the present contracts were negotiated in 1990.
Some of the contract provisions, such as generous on-call payments, had now become custom and practice, he said, and would be difficult to change.
The Auditor found that, according to sampling, 28 per cent of fee-for-service items claimed by VMOs were not evidenced by information on the patient medical record. Three per cent of the sample were for babies delivered when there was no record of the VMO delivering it.
Other discrepancies showed charges for assistants at operations when there was no record of them attending. Either the doctors did the treatment but did not record it or billed for services not provided.
“”In either case there appears to have been a breakdown in the professional accountability expected and in the management of the record-keeping and payment processes,” the Auditor said. The report said VMOs were charging for nine days of visits after every childbirth when most mothers stayed in hospital only four days.
There were allegations that in return for a fee of up to $500 doctors would book mothers in as public patients, but guarantee attendance as if they were private patients without delegating the delivery to the resident medical officer as required for public patients.
The Auditor recommended investigation, saying the absence of records had prevented the Audit office from investigating. Mr Berry said most if not all of the issues were being considered by the committee negotiating the contract renewal.
The president of ACT branch of the Australian Medical Association, Dr Mark Hurwitz, said the AMA would not tolerate fraud. However, the report showed discrepancies were not as bad as Victoria. “”It seems there were a lot of minor clerical errors that better documentation would have avoided,” he said.
The AMA would ask its members to document all attendances. He had not had the chance to look at the report in detail, but the AMA was prepared to meet discrepancies. The Leader of the Opposition, Kate Carnell, said that in renegotiating VMO contracts the ACT had to ensure it was paying enough to keep the best doctors here.